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Hepatitis C eradication with sofosbuvir leads to significant metabolic changes

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World Journal of Hepatology 2016年第35期8卷 1557-1563页

作者： Amilcar L Morales Zachary Junga Manish B Singla Maria Sjogren Dawn Torres Hepatology Service San Antonio Military Medical Center Gastroenterology Service Walter Reed National Military Medical Center Department of internal medicine Walter Reed National Military Medical Center

AIMTo assess the effect of sofosbuvir (SOF) based regimens on glycemic and lipid control. METHODSThis is a retrospective analysis of hepatitis C virus (HCV)-infected patients treated and cured with a SOF regimen [SOF/ribavirin/interferon, SOF/simeprevir, or SOF/ledipasvir (LDV) ± ribavirin] from January 2014 to March 2015. Patients with hemoglobin A1C (HbA1C) and lipid panels within six months before and six months after therapy were identified and included in our study. Due to the known hemolytic effect of ribavirin, HbA1C was obtained a minimum of three months post-treatment for the patients treated with a ribavirin regimen. medical history, demographics, HCV genotype, pre-therapy RNA, and liver biopsies were included in our analysis. The patients who started a new medication or had an adjustment of baseline medical management for hyperlipidemia or diabetes mellitus (DM) were excluded from our analysis. RESULTSTwo hundred and thirty-four patients were reviewed, of which 60 patients met inclusion criteria. Sixty-three point three percent were male, 26.7% were Caucasian, 41.7% were African American and 91.7% were infected with hepatitis C genotype 1. Mean age was 60.6 ± 6.7 years. Thirty-nine patients had HbA1C checked before and after treatment, of which 22 had the diagnosis of DM type 2. HbA1C significantly decreased with treatment of HCV (pretreatment 6.66% ± 0.95% vs post-treatment 6.14% ± 0.65%, P vs 0.71% ± 0.83%, P = 0.070). Fifty-two patients had pre- and post-treatment lipid panels; there was a significant increase in low-density lipoprotein (LDL) and total cholesterol (TC) after treatment (LDL: 99.5 ± 28.9 mg/dL vs 128.3 ± 34.9 mg/dL, P vs 199.7 ± 40.0 mg/dL, P P = 0.684). CONCLUSIONEradication of HCV with a SOF regimen resulted in a significant drop in HbA1C and an increase in LDL and TC post therapy.

关键词： Hepatitis C Sofosbuvir Hyperlipidemia Hemoglobin A1c Low-density lipoprotein

Sleep disturbances and predictors of nondeployability among active-duty army soldiers: an odds ratio analysis of medical healthcare data from fiscal year 2018

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Military medical Research 2020年第3期7卷 335-342页

作者： Jaime K.Devine Jacob Collen Jake J.Choynowski Vincent Capaldi Institutes for Behavior Resources Operational Fatigue and Performance2104 Maryland AveBaltimoreMD 21218USA Pulmonary Critical Care and Sleep Medicine Walter Reed National Military Medical CenterBethesdaMD 20889USA Behavioral Biology Branch Center for Military Psychiatry and NeuroscienceWalter Reed Army Institute of ResearchSilver SpringMD 20910USA

Background:The impact of sleep disorders on active-duty soldiers’medical readiness is not currently *** data generated at military treatment facilities can be accessed to create research reports and thus can be used to estimate the prevalence of sleep disturbances and the role of sleep on overall health in service *** current study aimed to quantify sleep-related health issues and their impact on health and nondeployability through the analysis of *** healthcare records from fiscal year 2018(FY2018).Methods:medical diagnosis information and deployability profiles(e-Profiles)were queried for all active-duty *** patients with a concurrent sleep disorder diagnosis receiving medical care within *** was predicted from medical reasons for having an e-Profile(categorized as sleep,behavioral health,musculoskeletal,cardiometabolic,injury,or accident)using binomial logistic *** e-Profiles were investigated as a moderator between other e-Profile categories and ***:Out of 582,031 soldiers,48.4%(n=281,738)had a sleep-related diagnosis in their healthcare records,9.7%(n=56,247)of soldiers had e-Profiles,and 1.9%(n=10,885)had a sleep *** with sleep e-Profiles were more likely to have had a motor vehicle accident(p OR(prevalence odds ratio)=4.7,95%CI 2.63–8.39,P≤0.001)or work/duty-related injury(p OR=1.6,95%CI 1.32–1.94,P≤0.001).The likelihood of nondeployability was greater in soldiers with a sleep e-Profile and a musculoskeletal e-Profile(p OR=4.25,95%CI 3.75–4.81,P≤0.001)or work/dutyrelated injury(p OR=2.62,95%CI 1.63–4.21,P≤0.001).Conclusion:Nearly half of soldiers had a sleep disorder or sleep-related medical diagnosis in 2018,but their sleep problems are largely not profiled as limitations to medical *** issues and physical injury predict nondeployability,and nondeployability is more likely to occur in soldiers who have sleep e-Profiles in addition t

关键词： medical readiness Behavioral sleep medicine Deployability Healthcare records Military Big data Data mining

Myo-inositol reduces β-catenin activation in colitis

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World Journal of Gastroenterology 2017年第28期23卷 5115-5126页

作者： Emily M Bradford Corey A Thompson Tatiana Goretsky Guang-Yu Yang Luz M Rodriguez Linheng Li Terrence A Barrett Division of Gastroenterology Department of Internal MedicineUniversity of Kentucky Department of internal medicine Northwestern University Feinberg School of Medicine Division of Cancer Research National Cancer InstituteDCP/GOCRGBethesda Department of Surgery Walter Reed National Military Medical Center Department of Pathology and Laboratory medicine University of Kansas School of Medicine and Stowers Institute for Medical Research

To assess dietary myo-inositol in reducing stem cell activation in colitis, and validate pβ-cateninS552 as a biomarker of recurrent *** examined the effects of dietary myo-inositol treatment on inflammation, pβ-cateninS552 and pAkt levels by histology and western blot in IL-10-/- and dextran sodium sulfate-treated colitic mice. Additionally, we assessed nuclear pβ-cateninS552 in patients treated with myo-inositol in a clinical trial, and in patients with and without a history of colitis-induced *** mice, pβ-cateninS552 staining faithfully reported the effects of myo-inositol in reducing inflammation and intestinal stem cell activation. In a pilot clinical trial of myo-inositol administration in patients with a history of low grade dysplasia (LGD), two patients had reduced numbers of intestinal stem cell activation compared to the placebo control patient. In humans, pβ-cateninS552 staining discriminated ulcerative colitis patients with a history of LGD from those with benign *** crypts with increased numbers of pβ-cateninS552 - positive cells can be utilized as a biomarker in colitis-associated cancer chemoprevention trials.

关键词： Chemoprevention Dysplasia Biomarker Stem cell Colitis-associated cancer

Practice parameters for the use of actigraphy in the military operational context: the walter reed army Institute of Research Operational Research Kit-Actigraphy(WORK-A)

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Military medical Research 2021年第1期8卷 103-115页

作者： Jaime K.Devine Jake Choynowski Tina Burke Kajsa Carlsson Vincent F.Capaldi Ashlee B.McKeon walter J.Sowden Operational Fatigue and Performance Institutes for Behavior ResourcesBaltimoreMD 21218USA Behavioral Biology Branch Walter Reed Army Institute of Research503 Robert Grant AveSilver SpringMD 20910USA Tripler army medical center HonoluluHI 96859USA

Background: The walter reed army Institute of Research(WRAIR) Operational Research Kit-Actigraphy(WORK-A) is a set of unique practice parameters and actigraphy-derived measures for the analysis of operational military sleep patterns. The WORK-A draws on best practices from the literature and comprises 15 additional descriptive variables. Here, we demonstrate the WORK-A with a sample of United States army Reserve Officers’ Training Corps(ROTC) cadets(n=286) during a month-long capstone pre-commissioning training ***: The sleep of ROTC cadets(n=286) was measured by Philips Actiwatch devices during the 31-day training exercise. The preliminary effectiveness of the WORK-A was tested by comparing differences in sleep measures collected by Actiwatches as calculated by Philips Actiware software against WORK-A-determined sleep measures and self-report sleep collected from a subset of ROTC cadets(n=140).Results: Actiware sleep summary statistics were significantly different from WORK-A measures and self-report sleep(P≤0.001). Bedtimes and waketimes as determined by WORK-A major sleep intervals showed the best agreement with self-report bedtime(22:21±1:30 vs. 22:13±0:40, P=0.21) and waketime(04:30±2:17 vs. 04:31±0:47, P=0.68). Though still significantly different, the discrepancy was smaller between the WORK-A measure of time in bed(TIB) for major sleep intervals(352±29) min and self-report nightly sleep duration [(337±57) min, P=0.006] than that between the WORK-A major TIB and Actiware TIB [(177±42) min, P≤0.001].Conclusions: Default actigraphy methods are not the most accurate methods for characterizing soldier sleep, but reliable methods for characterizing operational sleep patterns is a necessary first step in developing strategies to improve soldier readiness. The WORK-A addresses this knowledge gap by providing practice parameters and a robust variety of measures with which to profile sleep behavior in service members.

关键词： Actigraphy Sleep-wake patterns Military sleep assessment Operational environment Scoring methodology

Wavefront-optimized surface retreatments of refractive error following previous laser refractive surgery: a retrospective study

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Eye and Vision 2016年第1期3卷 22-28页

作者： Kevin M.Broderick Rose K Sia Denise S.Ryan Richard D.Stutzman Michael J.Mines Travis C.Frazier Mark F.Torres Kraig S.Bower Ophthalmology Service Walter Reed National Military Medical Center8901 Wisconsin AvenueBethesdaMD 20814USA Warfighter Refractive Eye Surgery Program and Research center Ft.BelvoirVAUSA Ophthalmology Service Madigan Army Medical CenterTacomaWAUSA The Wilmer Eye Institute Johns Hopkins UniversityBaltimoreMDUSA

Background:Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive *** different combinations of primary treatment methods and retreatment techniques have been studied,however,few studies have investigated wavefront-optimized(WFO)technology for retreatment following primary refractive *** study aimed to report the outcomes of WFO photorefractive keratectomy(PRK)retreatments of refractive error following previous laser refractive surgery with PRK,laser in situ keratomileusis(LASIK),or laser-assisted subepithelial keratectomy(LASEK).Methods:We reviewed records of patients who underwent WFO PRK retreatments using the Allegretto Wave Eye-Q 400 Hz Excimer Laser System(Alcon Surgical)between January 2008 and April 2011 at walter reed army medical center and Madigan army medical *** were recorded in terms of uncorrected distance visual acuity(UDVA),manifest refraction spherical equivalent(MRSE),corrected distance visual acuity(CDVA),and complications at 1 month(M),3 M,and 6 M ***:Seventy-eight patients(120 eyes)underwent WFO PRK retreatment during the study *** surgery was surface ablation in 87 eyes(78 PRK,9 LASEK)and LASIK in 33 *** mean spherical equivalent before retreatment was−0.79±0.94 D(−3.00 to 1.88 D).UDVA was≥20/20 in 69 eyes(60.0%)at 1 M,54 eyes(71.1%)at 3 M,and 27 eyes(73.0%)at 6 M *** was within±0.50 D of emmetropia in 78 eyes(67.8%)at 1 M,59 eyes(77.6%)at 3 M,and 25 eyes(67.6%)at 6 M *** was maintained within±1 line of pre-op in 113 of 115 eyes(98.3%)at 1 M,74 of 76 eyes(97.4%)at 3 M,and 37 eyes(100%)at 6 M ***:Although follow-up was limited beyond 3 M,WFO PRK retreatments in patients with residual refractive error may be a safe and effective *** studies are necessary to determine the long-term safety and stability of outcomes.

关键词： Wavefront-optimized PRK LASIK LASEK Retreatment Enhancement

Quantitative analysis of a panel of gene expression in prostate cancer——with emphasis on NPY expression analysis

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2007年第12期8卷 853-859页

作者： LIU Ai-jun FURUSATO Bungo RAVINDRANATH Lakshmi CHEN Yong-mei SRIKANTAN Vasanta MCLEOD David G. PETROVICS Gyorgy SRIVASTAVA Shiv Department of Pathology Chinese PLA General Hospital Beo＇ing 100853 China center for Prostate Disease Research Uniformed Services University of the Health Sciences Rockville MD 20852 USA Urology Service Walter Reed Army Medical Center Washington DC 20307 USA

Objective： To investigate molecular alterations associating with prostate carcinoma progression and potentially provide information toward more accurate prognosis/diagnosis. Methods： A set of laser captured microdissected （LCM） specimens from 300 prostate cancer （PCa） patients undergoing radical prostatectomy （RP） were defined. Ten patients representing ＂aggressive＂ PCa, and 10 representing ＂non-aggressive＂ PCa were selected based on prostate-specific antigen （PSA） recurrence, Gleason score, pathological stage and tumor cell differentiation, with matched patient age and race between the two groups. Normal and neoplastic prostate epithelial cells were collected with LCM from frozen tissue slides obtained from the RP specimens. The expressions of a panel of genes, including NPY, PTEN, AR, AMACR, DD3, and GSTP1, were measured by quantitative real-time RT-PCR （TaqMan）, and correlation was analyzed with clinicopathological features. Results： The expressions of AMACR and DD3 were consistently up-regulated in cancer cells compared to benign prostate epithelial cells in all PCa patients, whereas GSTP1 expression was down regulated in each patient. NPY, PTEN and AR exhibited a striking difference in their expression patterns between aggressive and non-aggressive PCas （P=0.0203, 0.0284, and 0.0378, respectively, Wilcoxon rank sum test）. The lower expression of NPY showed association with ＂aggressive＂ PCas based on a larger PCa patient cohort analysis （P=0.0037, univariate generalized linear model （GLM） analysis）. Conclusion： Despite widely noted heterogeneous nature of PCa, gene expression alterations ofAM,4CR, DD3, and GSTP1 in LCM-derived PCa epithelial cells suggest for common underlying mechanisms in the initiation of PCa. Lower NPY expression level is significantly associated with more aggressive clinical behavior of PCa; PTEN and AR may have potential in defining PCa with aggressive clinical behavior. Studies along these lines have potential to define PCa-associated gen

关键词： Prostate cancer NPY expression Quantitative real-time reverse-transcript polymerase chain reaction (RT-PCR)

Bacterial vaginosis:a synthesis of the literature on etiology,prevalence,risk factors,and relationship with chlamydia and gonorrhea infections

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Journal of medical Colleges of PLA(China) 2016年第2期31卷 93-103页

作者： Christian T.Bautista Eyako Wurapa Warren B.Sateren Sara Morris Bruce Hollingsworth Jose L.Sanchez Division of Health Research Lancaster University Lancaster UK. walter reed army Institute of Research Maryland USA Armed Forces Health Surveillance center and Cherokee Nation Technology Solutions Maryland USA

Bacterial vaginosis(BV) is a common vaginal disorder in women of reproductive age. Since the initial work of Leopoldo in 1953 and Gardner and Dukes in 1955, researchers have not been able to identify the causative etiologic agent of BV. There is increasing evidence, however, that BV occurs when Lactobacillus spp., the predominant species in healthy vaginal flora, are replaced by anaerobic bacteria, such as Gardenella vaginalis, Mobiluncus curtisii, M. mulieris, other anaerobic bacteria and/or Mycoplasma hominis. Worldwide, it estimated that 20%–30% of women of reproductive age attending sexually transmitted infection(STI) clinics suffer from BV, and that its prevalence can be as high as 50%–60% in high-risk populations(e.g., those who practice commercial sex work(CSW). Epidemiological data show that women are more likely to report BV if they: 1) have had a higher number of lifetime sexual partners; 2) are unmarried; 3) have engaged in their first intercourse at a younger age; 4) have engaged in CSW, and 5) practice regular douching. In the past decade, several studies have provided evidence on the contribution of sexual activity to BV. However, it is difficult to state that BV is a STI without being able to identify the etiologic agent. BV has also emerged as a public health problem due to its association with other STIs, including: human immunodeficiency virus(HIV), herpes simplex virus type 2(HSV-2), Chlamydia trachomatis(CT) and Neisseria gonorrhoeae(NG). The most recent evidence on the association between BV and CT/NG infection comes from two secondary analyses of cohort data conducted among women attending STI clinics. Based on these studies, women with BV had a 1.8 and 1.9-fold increased risk for NG and CT infection, respectively. Taken together, BV is likely a risk factor or at least an important contributor to subsequent NG or CT infection in high-risk women. Additional research is required to determine whether this association is also present in other low-r

关键词： Bacterial vaginosis Chlamydia Gonorrhea Military Epidemiology STI

Anesthetic Management of a Parturient with Thalidomide Phocomelia

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Open Journal of Anesthesiology 2012年第3期2卷 59-61页

作者： Samuel N. Blacker Tiffany E. Angelo Department of Anesthesiology Walter Reed National Military Medical Center Bethesda MD USA. Department of Anesthesiology Womack Army Medical Center Fort Bragg NC USA

The teratogenicity of thalidomide has been known since the early 1960s [1]. Thalidomide is currently used world wide, including the United States, to treat erythema nodosum leprosum, multiple myeloma, refractory Crohn’s disease, aphthous stomatitis and HIV wasting syndrome. New cases of thalidomide phocomelia are being reported as well. We report a case of the anesthetic challenges of a 23 year-old parturient with thalidomide phocomelia and review the important anesthetic challenges it presents. Spontaneous vaginal delivery under continuous lumbar epidural was achieved in this challenging patient. However, it required careful planning for reliable intravenous access and the use of magnetic resonance imaging (MRI) of her pelvis and lumbar spine.

关键词： Anesthesia Thalidomide Phocomelia Obstertric Anesthesia

Maspin Down-regulates the Expression of Prostate Specific Antigen in Human Prostate Cancer LNCaP Cells

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Maspin Down-regulates the Expression of Prostate Specific An...